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13040115CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 4 INFINITE LOOP CONTRACTOR: DEVCON PERMIT NO: 13040115 CONSTRUCTION INC OWNER'S NAME. APPLE COMPUTER INC 690 GIBRALTAR DR DATE ISSUED: 09/16/2013 O . ER'S PHONE: 4082051848 MILPITAS, CA 95035 PHONE NO: (408)942-8200 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL LICENSED CONTRACTOR'S DECLARATION License Class_ Lic. ft trAl� SOFT DEMO IN KITCHEN AREA, INSTALL _ Contractor DEVtts N i151�157 KrCiGTtQi�IDate 9Z,01i2i (N)EQUIPMENT, INCLUDING REFRIGERATOR, FRYER, SERVING STATION I hereby affirm that I am licensed under the provisions of Chapter 9 & (commencing with Section 7000) of Division 3 of the Business & Professions WALK-IN COOLER Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: 515000 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 31602108.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERNIIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, casts, and expenses which may accrue against said City in consequence of the I issued by: Date: granting of this permit. Additionally, the applicant understands and will comply t I •fl with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. �li� '�' la' • ,�'s`" ..�-,-.. Dat/_�r . RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, l agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERIINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sce.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipmeut or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued, will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Seeti ri3255O5,25533,a 25534. Section 3700 of the Labor Code, for the performance of the work for which this ,�� �r: gt ";' ��'. s"" .W ' 0, 0 r' L, - Own'o�autlinrtzedagenf. �• s-' ` : r ,FZ+,ti�Aat�:g�r19Zr3 permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after malting this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C,) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes, (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date RE CITY OF CUPERTINO BUILDING PE"HT BUILDING ADDRESS: 4 INFINITE LOOP CONTRACTOR: DEVCON PERMIT NO: 130401,15 CONSTRUCTION INC OWNER'S NAME: APPLE COMPUTER INC 690 GIBRALTAR DR DATE ISSUED: 08121/2013 OWNER'S PHONE: 4082051848 MILPITAS, CA 95035 PHONE NO: (408)942-8200 JOB DESCRIPTION: RESIDENTIAL ElCOMMERCIALEI a. LICENSED C NTRACTOR'S DECLARATION cense Class SOFT DEMO IN KITCHEN AREA, INSTALL Contractor OGAPWV) tfnM 2U1,&M Date 8 III20L3 (N)EQUIPMENT, INCLUDING REFRIGERATOR, FRYER, SERVING STATION I hereby affirm that I am Iicensed under the provisions of Chapter 9 & (commencing with Section 7000) of Division 3 of the Business & Professions WALK-IN COOLER Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a eertificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $15000 performance of the work for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 31602108.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMUT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 1$ WAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 1$0 DAYS M LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -poi source regulations per the Cupertino Municipal Code, Section la 9.18. �;ry ' _ 'ate= •-` ` . rl T t' RE -ROOFS: SAI r',' fs shall be inspected prior to any roofing material being installed: If a roof is `d iso without first obtaining an inspection, I agree to remove all new materials for inspeetion. ❑ OAVNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (See. 7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with lieensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous 1 have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Scelion 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management Distriet I performance of the work for which this permit is issued. will maintain enmpliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Cade, Sect' 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this -.. fi Q12416 O �I%kCll".' :t�'' . .'. : - '�u� � -_ rrn-. ate: V �� permit is issued. e�Sy 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is eorrcct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date U, CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 4 INFINITE LOOP CONTRACTOR: DEVCON PERMIT NO: 13040115 CONSTRUCTION INC OWNER'S NAME: APPLE COMPUTER INC 690 GIBRALTAR DR DATE ISSUED: 09/16/2013 01 ', R'S PHONE: 4082051848 MILPITAS, CA 95035 PHONE NO: (408)942-8200 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ APPLE -SOFT DEMO IN KITCHEN AREA, INSTALL License Class gA Lic. 0 )1-6095 (N)EQUIPMENT, INCLUDING REFRIGERATOR, FRYER, Contractor DE C0�j Ct^N >'' l6NDate Z ( (3 SERVING STATION & WALK-IN COOLER I hereby affirm that 1 am licensed under the provisions of Chapter 9 [0116120[3- DEFERRED #2- SHOP DRAWINGS AND CALCS FOR WALK IN (commencing with Section 7000) of Division 3 of the Business & Professions COOLER- ISSD 12/18/2013 Code and that my license is in full force and effect. ✓%,, I hereby affirm under penalty of perjury one of the following two de I have and will maintain a certificate of consent to self -insure for Worke # v [ 5 o Compensation, as provided for by Section 3700 of the Labor Code, for th 2 q. Ft Floor Arca: Valuation: $15000 performance of the work for which this permit is issued, �� have and will maintain Worker's Compensation Insurance, as provided Far by Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 31602108.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 D M LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the 1,2. ; granting of this permit, Additionally, the applicant understands and will comply Issued by: Date: with all non-po' ourc regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS - 81 att . ' Date)2,1117113 All roofs shall be inspected prior to any roofing material being installed. if a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ QWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (See.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain aCertificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain eomplinnee with The Cupertino Munieipal Code, Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Section , 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Irter:ciluttuitiylt cit; Dater 1 3 permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to became subject to the Worker's Compensation laws of California, If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this perrnit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct, I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of lie I understand my plans shall be used as public,reeords. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 4 INFINITE LOOP CONTRACTOR: DEVCON PERMIT NO: 13040115 CONSTRUCTION INC OWNER'S NAME: APPLE COMPUTER INC 690 GIBRALTAR DR DATE ISSUED: 09/1612013 ,101VNER'S PHONE: 4082051848 MILPITAS, CA 95035 PHONE NO: (408)942-8200 JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIALE] LICENSED CONTRACTOR'S ECLARATION icense Class^ Lic. # (1469-) APPLE -SOFT DEMO IN KITCHEN AREA, INSTALL - 3 (N)EQUIPMENT, INCLUDING REFRIGERATOR, FRYER, ContractorUl��n_L_/�t`�.{G-�id��Date P 2 SERVING STATION & WALK-IN COOLER I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business &Professions �.:. 101 2llh REVISCON �#1- REVISE�I'L�''A`l�',` AYQI-�Q11j-, ICE BAR is in �6% Code and that my license full force and effect, Df'S1 $�j}_1I/c+-Zr5(124I3 4]� I hereby affirm under penalty of perjury one of the following two declarations- ` 1 have and will maintain a certificate of consent to self -insure for Worlra Compensation, as provided for by Section 3700 of the Labor Ce �/ Sq. Ft Floor Arca: Valuation: $15000 performance of the work for which this permit is issued, ;VO.— N 1 1 have and will maintain Worker's Compensation Insurance,t<d for by Section 3700 of the Labor Code, for the performance of the wor for which this APN Number: 31602108.00 Occupaney Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and slate that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. l agree to comply with all city and county ordinances and state laws relating WITHIN 0 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DA R M LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Issued by: Date: granting of this permit. Additionally, the applicant understands and will comply withall non-po' source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: a �s All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OW ElV R -BUILDER DECLARATION Signature of Applicant: Dale: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sce.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the Califoruia Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(x) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Arca Air Quality Management District I performance of the work for which this permit is issued, will maintain compliance with the Cupertino Municipal Code, Chapter 9,12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Section 5505, 2 3, an 25534. Section 3700 of the Labor Code, for the performance of the work for which this Ovine ar- tttltn s i; �nl:Date: permit is issued. .ized . _ _, I certify that in the performance of the work for which this permit is issued, l shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LEND] G AGENCY become subject to the Worker's Compensation provisions of the Labor Code, l must 1 hereby affirm that there is a construction lending ageney for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name PPLICANT CERTIFICAlf[ON Lender's Address I certify that I have read this application and state that the above information is _ correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT" DECLARATION costs, and expenses which may accrue against said City in consequence of the 1 understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CONSTRUCTION PERMIT APPLICATION ~1�� COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (j_V (408) 777-3228 • FAX (408) 777-3333 • buildingCcDcuyedino.org ff CUPERTINO I—I I—t I I� F I O NRW CNSTRUCTION I I ADDITION I 1 ALTERATION / TT I REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS - ` TJ ( Te 5 C70P - APN # 15 1 UP ` pz, -10 15 OWNER NAME A^P' r jYi�I3F,., 2v�, r S� e E-MAIL STREET ADDRESSO� I ti I � l� OF, CITY, STATE, ZIP ^f b J �/ FAX CONTACT NAME PHONE �,AIL fida14P�EGH • _! t)3 •3 STREET ADDRESS CITY, STATE, ZIP FAX / I-]OWNERElOWNER-RUTLDER VWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME �^ W� LICENSENHMBER� LICENSE TYPE BUS.LIC!! COMPANY NAME ry ` , )iMA1Lm d.g � D FAT N r •n STREET ADDRESS Q1 l D� • CITY, STATE, IP� PHOI�$ 6 +Z• %%2400S -1 ARCHITECTlENGINEERNAME OR LICENSE NUMBER BUS. LIC# COMPANY NAME E-MAIL C.tAd -Li FAX (oS0• 3 S77LEETADDRESS h � 9 n ` tW CI ST ,ZIP PHONE $ �_• ' t0`t' IG^"'T DESCRIPTION OF WORK lQelko A.- OEW fCCDV � v�P EXISTING USE PROPOSED USE CONSTR. TYPE # STORES USE TYPE OCC. SQ.FT. VALUATION ($) PJ 1 A L. EXISTG�y AREA 15-14-7 ► NEW FLOOR �y AREA � 14 ,2- DEMO TOTAL AREA� NET AREA '}' �� 4 \ 15, 00 {u • Oa BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMObELAREA PORCH AREA DECK AREA TOTAL DECKIPORCR AREA GARAGE AREA: DETACH ❑ ATTACH #DWELLING TWITS: ISA SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑NO ADDITION? ❑NO PRE -APPLICATION ❑YES 1F YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RE TOTAL VALUATION: PLANNING APDL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO , S, OOL7 By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on erty owner's behalf. I have read this application and the information I have provided is correct. I h e r d the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to lding construct' a resentatives of Cupertino to enter the above-ide 'fled property for inspection purposcs, Signature of Applicant/Agent: A JA Date: SUPPLEMENTAL INFORMA ION U][RED PLAN CHECK TYPE IkOUTING SLIP ❑ New SFD or Multifamily dwellings: Apply for demolition permit for _ existing building(s), Demolition permit is required prior to issuance of building OVER-THE-COUNTER L BUILDING PLAN REVIEW r permit for new building. ,� F?CYRESS ' PLANNLNG PLAN REVIEW, _ Commercial Bldgs: Provide a completed Hazardous Materials DisclosureI-LARGE TANDARO ❑PUBLICWORus form if any Hazardous Materials are being used as part of this project. £. �FIRE DEPT , _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑AOR' !!!!I!❑ SANTlARY SEWERpiSTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH.. B1dgApp_2011.doc revised 06121111 S��0�6 Of- worc-tc__ CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIOI 1030D TORRE AVENUE • CUPERTINO, CA 95014-3255 ' CUpERTINO (408) 777-3228 • FAX (408) 717-3333 • building(Ocuperlino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION D RIGINAL PERMIT # I So 4d 115' PROJECr ADDRESS / Fl L / _ 4 APN # OWNERNAME rtfNG TONE AI I ,Za /O KLyn� STREETADDRESS CITY, STATE, ZIP et 9--�4, /v& FAX CONTACT NAME PHONE408 9104_.zg: I< STREET ADDRESS r ( CrrY STATE, ZI 9,/� FAX ❑ OWNER 13OWNER-BWZER ❑ OWNERAGENT ❑ CONTRACTOR CONTRACTOR AGENT ❑ ARCHIIECr Q ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME 7 LICTSEIrBER 1!' LICENSE TYPE SUS. LIC # I (99COMPANY NAME -� (f1)���- J E-MAIL lee ��} f [TEJ, FAX STREET ADDRESS 6 l n 7C CTTV, ST ZIP f5 �f S ARCHTTECTIENGINEERNAME C�K�l1 - r LICENSE NUMBER BUS. LIC# COMPANY NAME � �L EMAIL f � � s, ` C FAX STREET ADDRESS CrfY, STATE. ZIP PHONE DESCRIPTION OF WORK �JC161 { 11 :Fee- ez&x er)ep, o,7 ftA() �e.5`�'�CCiG✓n Prl'�CJ\!r-t -�'' i �/l s Gi-7 EXISTING USS PROPOSED USE CONSTR. TYPE d STORIES USE TYPE OCC, SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL ' AREA AREA AREA NET AREA ' BATHROOM KrrCHEN OTHER REMODELAREA REMODELAREA REMODELAREA PORCH AREA pECKTIS TOTAL DECEJPORCH ARBA GARgGH AREA: DETACHE]ATTACH # DWELLING UNITS:ASECONDUNIT []YES SECONDSTORV []YESEINGADDED? ❑NO ADDITION? []NO PRE -APPLICATION []YES IF YES, PROVIDE COPY OF IS THE RLDG AN ❑ YES TOT �01 Rij PLANNINGpPPt# []NO PLANNEdGAPPROVALLEfrER E[CHLERk[OM1fE? -❑NO M[V'- By my signature below, I certify to each of the following: 1 am the property owner or authorized agent to act on the property owner's behalf. l have read this application and the information I have vided is correct, I have re d the Description of Work and verify it is accurate. I agree to comply with all applicable local' ordinances and state laws relating to d g construction. 1 au ize representatives of Cupertino to enter the above -identified property For inspection purposes. Signature of ApplicantlAgent: Date: / 1 SUPPLEMENTAL ORMATION UIRED PLAN CITECK TYPE ROU'TINGSLIP ❑ OVER-THE-COUNTER BUILDING PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance ofbuilding permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 01POSTA,N'DARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to 1:1 MAJOR ❑ SANrrARY SEWER DISTRICT submittal of Building Permit appliention. ❑ ENVIRONMENTAL HEALTH, BldgApp_2011.doc revised 06/11/11 Pam fLl1 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE= • CUPERTINO, CA 95014-3255 CUPt=RTINO (406) 777-3228 • FAX (408) 777-3333 • build ingCcDcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERA 710NJ Ti, !A REV IO 1 D FERRED ORIGINAL PERMIT 9 131`- 0'4'0 -11 PROJECT ADDRESS APN 6 OWNERNAME! PH . E,t, (5 p b E-MAIL \, V STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME PH91qE1E-MAIL - STREETADDRESS�-y CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNFA•BUILDER ❑ OWNER AGENT 0vn;ACTOR ❑CONTRACTORAGENT ❑ ARCHMCT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC H COMPANY NAME E-MAIL FAX STREET ADDRESS CrIY, STATE, 7.1P PHONE ARCFHTECrIENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME &MAIL FAX STREET ADDRESS CrIY, STATE, ZIP PHONE DESCRIPTION-VvOF `WORK }p C.I.I mY L 'Iel EXISTING USE PROPOSED USEC11NSTR. TYPE I STORIES USE TYPE OCC- SQ.FT. VALUATION (S) EXISTGNEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AT.1 TOTAL DECKIPURCH AREA GARAGE AREA: DETACH ❑ ATTACH P DWELLING UNITS: A SECOND UNIT ❑YES SECONDSTORY ❑YES EING ADDED? []NO ADDITION? ❑NO PRE -APPLICATION DYES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES ' RECEIVED BY:" TOT VALUATION: PLANNING APPL N [:]NO PLANTMNG APPROVAL LETTER EICHLER HOME? []NO By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. 1 have read the Description Of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building onstruction. 1 authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applieant1Agent;Date: SUPPLEMENTAL INFO A RE U1RED Q r., _ - -PL .ANCI[ECK-TYPE'___... _-ROUTING-SLIP:`-,.�,.�,-_ � J 0 i,•-OVF,R-THE-COUNTER, • - i I] f1U1LI)INGPLAN'REVIEIY . _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building' permit for new building. ,❑- larlihss ❑ Pt:ANNI'1tiG'PLAN REVIEIV' Bldgs: Provide a completed Hazardous Materials Disclosure 1]o STANDAAI)a - ''' ❑''.PUDLICIVORICS _Commercial form if any Hazardous Materials are being used as part ofthis project. _ '' ❑ LARGE;FIRC IT * ' DEPT; _ Copy of Planning Approval Letter or Meeting with Planning prior to 'A -' ~ _ : Iti1AdOR' +.. 0 SANITARY SEWER_DISTRICT submittal of Building Permit application. - .R .'❑_-ENVIROPIAfEI`11'ALIIEALTH . SldgApp 2011.doc revised 06121111 .o CITY OFCUPERTINO 7 FEE ESTIMATOR - BUILDING DIVISION v ADDRESS: 4INFINITE LOOP DATE: 04/1512013 REVIEWED BY: MELISSA ,lfech. Pertrail Fee: APN: 316 02 108 BPA: 5 Other Plumb Inslr. *VALUATION: 1$15,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY USE: Commercial Building $0.00 PENTAMATION PERMIT TYPE., 1GENCO M WORK "SOFT DEMO IN KfTCHEN AREA INSTALL N EQUIPMENT INCLUDING REFRIGERATOR SCOPE FRYER, SERVING STATION, ETC 1 hrs $0.00 NOTE: This estimate does not include fees due to other Departments (!.a Planning, Public Works, Fire, Sanitary Sewer District, .Sc11001 District, etc). Thesefees are based on the preliminary inkr►nation available and are only an estimate- Contact the Dept fr addn7 info.. FEE ITEMS(Fee Resolution 11-053 L . 711112 Afeclr. flan Check Plumb. Placa Check Elea Plan Check ,lfech. Pertrail Fee: Plumb. Permil Pec: 1lec. Pe"nit Pee: Oiher Alech, Insp.. Other Plumb Inslr. purer Elco. Insp. Lj Alech. hasp. 1'ec. Phanah. hrap•'Fee: Dee. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (!.a Planning, Public Works, Fire, Sanitary Sewer District, .Sc11001 District, etc). Thesefees are based on the preliminary inkr►nation available and are only an estimate- Contact the Dept fr addn7 info.. FEE ITEMS(Fee Resolution 11-053 L . 711112 FEE QTY/FEE MISC ITEMS Plan -Check Fee:. Hourly Only? C) Yes (D No $0.00 4 hours Plan Check, Hourly $532.00 1STPLNCK Suppl. PC Fee: (D Reg. Q OT0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? ()Yes Q No $0.00 Suppl. Insp. Fee -0 Reg. Q OT 0,0 1 hrs $0.00 PME- Unit Fee: $0.00 PME Permit Fee: $0.00 Corislt ut iion Tax: T -T - Administrative Fee: Q Work Without Permit? Yes (F) No $0.00 Advanced PlanninL Fee: $0.00 4 hours Inspections $532.00 LISTINSP 7 Inspection, Hourly Q � Trm,el Documentation Fees: Strom. Motion Fee: 1BSEISAECO $3.15 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $4.15 $1,064.00 TOTAL FEE: $1,068.15 Revised: 0410112013 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION UM ADDRESS: 4 INFINITE LOOP DATE: 04/1512013 REVIEWED BY: MELISSA Mech. Perwii Fee: APN:. 316 02 108 BP#: *VALUATION: $15,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: ' Tenant Improvement PRIMARY, USE: Commercial Building PENTAMATION PERMIT TYPE: 1 GENCOM woRK SOFT DEMO IN KITCHEN AREA INSTALL N EQUIPMENT INCLUDING REFRIGERATOR .SCOPE -FRYER, SERVING STATION, ETC NOTE: This estinrate-does not include fees due to other Departments (i.e. Planning, Public Warks, Fire, Sanitary Sewer District, Sellool District. etc). These fees are based on the nrelindnary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/12) bfech. Plan Cheek Phanh. Plan C'hec'k Elec„ Plan Check Mech. Perwii Fee: Plumb. Pennit Fee: Del. . Pennil Fee" Other Afech• Insp. Other Plumb Insp. Outer Elec. Insp. hlech.lnsp, Fee: Phallb, Insp, Fee: flee. Insp. I'ee: NOTE: This estinrate-does not include fees due to other Departments (i.e. Planning, Public Warks, Fire, Sanitary Sewer District, Sellool District. etc). These fees are based on the nrelindnary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? C) Yes Q No $0.00 = hours Plan Check, Hourly $532.00 ISTPLNCK Suppl. PC Fee: Q Reg. Q OT 0.0 1 hrs $0.00 PME. Plan Check: $0.00 Permit Fee: Hourly Only? ()Yes Q No $0.00 .Suppl. Insp:'Fee:Q Reg. Q OT 0,0 his $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Conso-w-lion Tezr.• Adrnirrisit utive. Fee: Q 0 Work Without Permit? Yes No $0.00 A'dvaiieed P[4n& Fee: $0.0f:$532.001 4 hours Inspections ISTINSPInspection, Hourly 0 Travel Documentation Fees: Strong, Motion Fee: IBSEISMICO $3.15 Select an Administrative Item Bldgs Comm ission Fee: IBCBSC $1.00 SUBTOTALS: $4.151$1,064.001 TOTAL FEE: 1 $1,068.95 Revised: 0410112013 CITY OF CUPERTINO ll FEE ESTIMATOR — BUILDING DIVISION 10 ADDRESS: infinite Loop 4 DATE: 0810812013 REVIEWED BY: Arnold H. PC + I E ID APN: 316-02-908 BP#: 13040115 `VALUATION: $0 xPERMrr TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement FWMARY USE: Commercial Building 01hei-Efer. Imp. Ll PENTAMATION PERMIT TYPE: IDS WORK Reference Only Drawings for AccessibilitV, Deferred Submittal. SCOFF, 0,0 OCCUPANCY TYPE: TYPE OF CONSTIi. FLR AREA (9 --f PC FEES PC + I E ID BP FEES BP FEE ID Deferred Submittal (Not R-3) I-A,I-'B 0 $0.00 01hei-Efer. Imp. Ll $0,00 Phnn& hap. Fee: Elec.lrrsp..ree: Suppl. Insp. Fec:0 Reg. Q OT 0,0 hrs $0.00 PIE Unit Fee: $0.00 PME Permit Fee: $0.00 Cvnsrrtrction Tett. .•Ir; min! irtuive 1*ec: 0 Work Without Permit? Yes (D No $0.00 Advanced Planning Fee: TOTALS: 0 $0 DO { t1 " $0.00 $0.00 11)I.`�(7 �,YeS toTJ .a X'GIFIIy -A3-r. :kfech. Phpr Chock f'iuynb. Phsr Gtreck filer. Phrn Check Afech. Perirrit Fee., --L--j Phtmh. Perron Fec•.' ,Flet,. Pcrnrir Fee: C?i$er e, frrsjr." otherPharib frrap. 01hei-Efer. Imp. Ll life -ch. lr3cp. Fee: Phnn& hap. Fee: Elec.lrrsp..ree: N07E: This estimate does not hwfude fees due to other,0epartnreuts (i.e. Planning, Public Works, Fire, Sanitary Server Aistrict, School District etG1. These fees are Lased on the nrelinrinaru information available and are only an estimate. Contact the Dent for adds 3l info. FEE ITEMS (FeeResolution 11-053 EfF._7/1/121 FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Q Yes (F) No $0.00 2 7 hours Plan Check, Hourly $278.00 1ST'PLNCK Suppl. PC Fee: (D Reg. ® OT 0.0 hrs $0.00 PME Plan Check: $0.00 Pen -nit Fee: $0.00 Suppl. Insp. Fec:0 Reg. Q OT 0,0 hrs $0.00 PIE Unit Fee: $0.00 PME Permit Fee: $0.00 Cvnsrrtrction Tett. .•Ir; min! irtuive 1*ec: 0 Work Without Permit? Yes (D No $0.00 Advanced Planning Fee: $0,00 Select a Non -Residential E) Building or Structure 0 7�a�+e2Dacitrnetyfrtlit;n Rees: Strong Motion Fee: $0.00 F 2.07 hrs Inspections $278.00 wisABLINS Accessibility Inspection Bldg Stds Commission Fee: $0.00 '�Q1I4= $0.00 $556.00: r�(JTII`t.` r.�v.r 556.00 Revised: 07/01/2013 CITY OF CUPERTINO FEE ESTIMATOR -- BUILDING DIVISION NOTE. This estimate does not include fees due to other Departments rie. Planning, Public Works, Fire, Sanitary Sewer District, School Distrirt_ eir_ L Those feet are hated an the nretiminary information available and are only an estimate. Contact the Dent for addn't info. FEE ITEMS Fee Resoluti n 11-0.53 UZ 7/1%13 ADDRESS: 4 infinite loop DATE: 1011712013 REVIEWED BY: Mendez fiferh• Permit Fee: APN: BP#: 13040115 *VALUATION: 1$5,000 *PERMIT TYPE: Building Permit PLAN,CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: Phuub. Insp. Few ENTAMATION [PERMITTYPE: A WORK a le- deferred #2 shop drawin sand talcs for walk in cooler SCOPE $0.00 NOTE. This estimate does not include fees due to other Departments rie. Planning, Public Works, Fire, Sanitary Sewer District, School Distrirt_ eir_ L Those feet are hated an the nretiminary information available and are only an estimate. Contact the Dent for addn't info. FEE ITEMS Fee Resoluti n 11-0.53 UZ 7/1%13 Nfech. flan CheckPirutrb. Plum Circck F;Icc. Plan Check fiferh• Permit Fee: Plumb. Permit Fee, Flee. Permit Fee: Other Mech. Imp. OtJrer Plumb Insp. Other Dec. Insp. I-- Ilech. Imp. Fee: Phuub. Insp. Few Elec. Insp. Fee: NOTE. This estimate does not include fees due to other Departments rie. Planning, Public Works, Fire, Sanitary Sewer District, School Distrirt_ eir_ L Those feet are hated an the nretiminary information available and are only an estimate. Contact the Dent for addn't info. FEE ITEMS Fee Resoluti n 11-0.53 UZ 7/1%13 FEE QTYIFEE MISC ITEMS Plan Check Fee: $0.00 Select a Misa Bldg/Structure or EIement of a Building Suppl. PC Fee: E) Reg. Q OT 0:0firs $0.00 PME Plan Check: $0.00 Permit•Fee: $0.00 Suppl. Insp. Fee 0 Reg. Q OT 0;0 firs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee: Q Work Without Permit? © Yes No' $0.00 Advanced Planning Fee- $0.00 Select a Non -Residential Building or Structure Q o i T owl Documentation Fees: Strong Motion Fee: IBSEISMICO $1.05 1 # $834.00 Revisions 1REYCOMTI Tenant Improvement Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $2.05 $834.001 TOTAL FEE: $836,05 Revised: 10/01/2013 CUPERTINO CONSTRUCTION P'ERMIT APPLICATION \ COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION) 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 •building .cupertino.orp ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION IT] IL`J, ISI I DEFERRED ORJGINAL PERMIT 0 15 PROJECT ADDRESS A— APN k OWNER NAME � P1401q.1E � �� _3�1 EM•f�IL � L`L • 1 �J ,� STREET ADDRESS1 CITY, STATE, ZIP FAX CONTACT NAME � PHONFr � - -MAIL ^ h may, � COiVs `FAAXl.7�.V STREET ADDRESS l� CITY STATE`, ZlPh Q El OWNER 13OWNER•BUB.DER E3 OWNER AGENT' 1:1 CONTRACTOR 11❑? CONTTtACTOR AGENT ARCHITECT ❑ ENG21EEK ❑ DEVELOPER ❑ TENANT CONTRACTORNAME LICENSENUMBER LICENSETYPE BUS. LIC 4 COMPANY NAME E-MAIL FAX STREET ADDRESS CTI"Y, STATE, ZIP PHONE ARCHTTEC'NENGINEER NAME LICENSE NUMBER BUS. LIC S COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONST'R TYPE 11 STORIES USE TYPE OCC. SQ•FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKlPORCH AREA' REA GARAGE ARPA: DETACH ❑ ATTACH flDWELLINGUNITS: ISASECONDi7NIT ❑YES SECOND STORY []YES BEING ADDED! ❑NO ADDITION' MNO PRE -APPLICATION []YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES :'RECEIVEDBY:-"x -y - " - =" "` TOTAL VALUATION: PI-ANNING APPL H ❑ NO PI-ANNING APPROVAL LETTER EICHLER IIOME' []NO - 1� _ a� By my signature below, 1 certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. 1 have read this application and the information I have provided is correct. 1 have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building c nstruction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: fli 112 SUPPLEMENTAL INFORNJATfOKREQUIRED PLAN CTIEC.KUT.YPE _ a.. ROUTING SLIP? ` L7 OVER=THE-COTJNTER ❑ -4U DINGLANRLVt£W. _ New SFD or Multifamily dwellings: Apply for demolition permit for existing buildings). Demolition permit is required prior t0 issuance of building � " _ � , permit for new building. EXPITE$S ,ry i ❑• PLARr'iNd PLAN.REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ;CI STAN6AR➢ Q PUBLIC WORKS _ form if any Hazardous Materials are being used as part of this project. LARGF,^_ FIRE DEPT' _ Copy of Planning Approval Letter Or Meeting with Planning prior to `t '^0, lITe4TOR - ' • _ ❑ ARYSEL SANI1'YERDISTR1CT' submittal of Building Permit application. - - - •'�... ..MJENVIAONh1Ef4TAL`HEALT1I,r Bldg.4pp_2011.doc revised 06121111 .CO %h CITY OF CUPERTINO Ill FEE ESTIMATOR -- BUILDING DIVISION 10 ADDRESS: 4 infinite loop DATE: 10117/2013 REVIEWED BY: Mendez fLkrck. pe' -roil Fac'' DPN: BP#. 13040115 'VALUATION; j$10,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION USE: PERMIT TYPE: WORK revision #1- revise plan layout for 'uice bar design SCOPE $0.00 NOTE: This estimate does not include fees due to other Departments Ci e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the Drelinunary information available and are only an esdinate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolulion 11`053 Eff. 711113) Nferh. Plan Check Phnsb. Plurr Check Elec. Plan Check fLkrck. pe' -roil Fac'' Plr1mh. Pcrmir Fee: f lec.. Pernrir Fee. Oilier hfech. Insp. Ocher Plumb Insp. Other Elec. Insp. Ll 110th. Irup; Fcc: Pluwh. hrsp. fee: Elec. Insp. Frye: NOTE: This estimate does not include fees due to other Departments Ci e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the Drelinunary information available and are only an esdinate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolulion 11`053 Eff. 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building SuppI. PC Fee: (F) Reg. • OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.Q Reg. Q OT 0,0 -hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consli•uction Tax: Adininistrat i ve Fee: Q G Work Without Permit? Yes (F) No $0.00 Advanced Plazming Fee: $0.00 Select a Non -Residential Building or Structure t Travel Doeurnenta6017 Fees: Strong Motion Fee: IBSEISMICO $2.10 1 # $834.00 Revisions IREVCOMTI I Tenant Improvement Bld..Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $3.10 $834.00 TOTAL FEE: $837.10 Revised: MOV2013 HAZARDOUS MATERIALS CHECKLIST COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 1 CUPi✓RTINO � UFFIL;E --"� (408) 777-3228 •FAX (408) 777-3333 • buildinA(cDcupertino.org i t;uPURPOSE To minimize possible delays that would result for the Fire Department plan review, please complete the following checklist to determine if an additional level of Hazardous Materials plan review will be required. MARK 'YES' IF THE PROPOSED SCOPE OF WORK INCLUDE ANY OF THE FOLLOWING? PLEASE MARK YOUR ANSWER WITH AN 'X' IN THE YES OR NO BOX ON THE SIDE BELOW. YES NO 1. Use, dispensing, mixing or storage of flammable or combustible liquids or gases, hazardous materials, etc. f 2. Battery back-up rooms or racks. V 3. Propane tanks. ✓ 4. Gasoline stations with underground tanks. ✓ 5. Installation or replacement above ground or underground storage of liquid petroleum products, liquefied petroleum gases, compressed natural gas, explosives or other regulated hazardous materials. 6. Gas rooms for dentist, doctors or veterinarians. ✓ 7. Generators with back-up diesel or other fuels. ✓ 8. Large refrigeration systems. 9. Fuel cell systems. f 10. Commercial pool systems. 11. Chemical Storage areas. 12. Flammable liquid storage. 13. Compressed Gases. ✓ 14. Dry cleaners. `J 15. Print Shops.° �gD ✓ 16. Auto Repair and Auto Body Shops. 2 2M f 17. Research and Development. ]Mr - For any additional information regarding this checklist, please contact Hazardous Materials Specialist, Santa Clara County Fire Department, at (408) 378-4010. HasMa1 2011.doc revised 03107111